1136 - Stereotactic Body Radiation Therapy vs. Surgical Resection for BCLC Stage 0 Hepatocellular Carcinoma: A Propensity Score-Weighted Analysis
Presenter(s)
H. I. Lee1, J. Jung1, G. W. Song2, and S. M. Yoon1; 1Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), 2Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South)
Purpose/Objective(s):
Stereotactic body radiation therapy (SBRT) has emerged as a promising curative treatment for hepatocellular carcinoma (HCC), with a recent randomized trial demonstrating its superiority over radiofrequency ablation. However, its adoption as a primary treatment option has been constrained by the paucity of data in this setting. This study aimed to evaluate the long-term outcomes of SBRT versus surgical resection as first-line treatment in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 HCC.Materials/Methods:
In this single-institution retrospective study, we analyzed 537 patients with treatment-naïve, single HCC =2 cm who underwent surgical resection (n=450) or SBRT (n=87) between 2015 and 2023. We employed inverse probability of treatment weighting (IPTW) to balance baseline characteristics, comparing overall survival (OS), disease-free survival (DFS), cumulative incidence of overall and intrahepatic recurrences, and toxicities between the groups. Survival analyses were performed using Cox proportional hazards models for OS and DFS, while competing risk models were used for recurrence outcomes.Results:
With a median follow-up of 55.8 months (range, 8.3–117.0), the unweighted 5-year OS rates were 95.6% in the resection group and 83.9% in the SBRT group (hazard ratio [HR] 4.14; 95% confidence interval [CI], 1.96–8.71; P<0.001), and the 5-year DFS rates [were 68.1% and 58.6%, respectively (HR 1.76; 95% CI, 1.17–2.64; P=0.006). After IPTW adjustment, the survival and recurrence outcomes were comparable between groups in terms of 5-year OS rates (93.8% vs. 96.0%; HR 1.16; P=0.766), 5-year DFS rates (64.7% vs. 75.2%; HR 1.18; P=0.562), and 5-year cumulative incidences of both overall recurrence (32.3% vs. 35.8%; HR 1.13; P=0.689) and intrahepatic recurrence (31.8% vs. 31.2%; HR 0.97; P=0.918). Grade =3 complications occurred in 31 (6.9%) patients after resection, whereas no severe toxicities were observed following SBRT.Conclusion: SBRT demonstrated comparable outcomes to surgical resection after adjusting for baseline imbalances, with favorable toxicity profiles. These findings support SBRT as a viable first-line curative option for patients with BCLC stage 0 HCC who are suboptimal surgical candidates. Further prospective studies are warranted to optimize treatment strategies in this patient population.